Discharge planning
When does discharge planning begin?
Upon admission
What is one positive coping skill you can educate your member to utilize once they are discharged.
Meditation, breathing, walking, exercise, reading
What are some goals you can assist members with while in the hospital.
Stress management, communication, coping skills.
The process that occurs when members are not given needed exams, test, services and resources to diagnose and treat a medical condition is called:
Underutilization
What are some of the social supports we can assist members with?
Daily tasks or ADL's
Financial
Housing
Therapy
Community Resouces
What are key elements of discharge planning.
1. Medication reconciliation
2. Review member's living environment
3. Review needs
4. Explain test results, make f/u appointments, provide resources, refer to other departments
What is the difference between positive and negative coping skills.
Positive makes you feel good about yourself, healthy increases esteem.
Negative bad habits, unhealthy quick fixes, illegal substances and things that don't always make you feel good.
What can you do to help yourself to achieve members goals.
What are some examples of high-risk members who might be a discharge obstacle.
No residency status
abandoned
Little or no support
Need specialized rehab
Terminal Illness
Psychiatric meds, hospitals and crisis centers are examples of this?
What are traditional mental health methods.
What is the difference between short- and long-term goal.
Short accomplish goals in a short period of time.
Long term accomplishes in a longer period of time.
What are coping skills?
Activities that help members manage stress anxiety and depression that help increase our members over all wellbeing.
What is a long term goal you can assist a member to work towards when discharged.
Taking medications, maintaining therapy appointments, maintaining positive relationships, practicing positive copying skills.
How can a multidisciplinary team help with discharge planning?
A multidisciplinary team plays a crucial role in d/c planning by collaborating and coordinating efforts
to ensure a smooth transition for patients from a healthcare facility
What do discharge plans do.
Outline the necessary steps and resources required for the patients continued care and recover
What characteristics would a high-risk member present with?
No phone, no PMD, lack of transportation, no medications.
What disease has the highest readmission rates according to the readmission rate by payor slide?
What is congestive heart failure.
What is a short term goal you can assist member to work on once discharged
Shower everyday, get dressed, walk, eat healthy etc.
How can a multidisciplinary team assist with d/c planning?
Assessment and Evaluation
Care Coordination
Individualized plans of care
Education and training
Addressing Barriers
Communication and follow up and monitoring.
What are the most common adverse events after hospital discharge.
What are
Medication Errors
Falls and Injuries
Malnutrition and dehydration
Readmission
What are the four key Health Associates that assist in the patient's discharge planning.
1. Patient care facilitators
2. Care coordinators
3. Social Workers
4. Utilization review Nurses
Members who are discharge have a high risk of readmittance within how many days.
30-90 days
Therapy, support networks, health management, and living accommodations are examples of what?
What is discharge planning.
What are the key components of a discharge plan?
Medication Management
Education and communication
Patient and family education
Communication with medical personnel
Involving the patient and family
What is crucial for sustaining healing growth and recovery.
Ongoing Care